On Friday, March 7 I ran something of an experiment in crowdsourcing information via social media. At that time I was attending an evidence-based medicine (EBM) conference at Duke University, and during Friday’s closing session I was asked if I would discuss how we can use Twitter as a way to share and discuss EBM resources and information.

Two of the examples I gave were pretty straightforward. The first example was showing that Twitter can reach broad audiences and share information outwards towards those audiences. The second example was a discussion of TweetChats, including the #MedEd tweet chat and the BMJ Evidence-Based Nursing Twitter journal club.

The third example was a sort-of almost experiment. Just about 12:30 pm, I posted this post on this blog. At 1 pm I posted these tweets:

Within these responses were actionable, easy-to-use, up-to-date evidence-based recommendations for care. This was not truly an experiment: @btuttle knew that I was going to run this test, but did not know the precise time or content of the request, and I did mention the #DukeEBM tag during the #MedEd chat: folks were aware that this test was going to happen, but did not know the specifics.

Overall, I think we proved the point: the Twitter community can and will respond effectively when we ask for help. I think we also showed that these responses can help advance the cause of evidence-based medicine and improve healthcare for all our patients.

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I am going to use this blog post for an experiment. I am currently attending an evidence-based medicine (EBM) conference at Duke University. This conference is excellent, and I heartily recommend it for anyone interested in better understanding EBM and in being a more effective teacher of EBM. (This is not a paid ad–they don’t know I’ve written this; it really just is a great conference!)

That, however, is something of an aside.

I am writing this blog post as part of an experiment I hope to run during tomorrow’s closing session. We will be discussing new and interesting ways to work with EBM, and will be introducing participants to new EBM ideas.

The experiment, then, will be for me to tweet out a request for help and see how quickly and how well Twitter can respond. I will share the results with those attending the conference.

If you respond, please use the following hashtag — #DukeEBM — and use S1 or S2 according to which scenario you are responding.

S1: You are a family physician working in a small rural emergency room. An 18 year-old male patient presents in status asthmaticus. He is tachypneic, and does not respond to 3 combined albuterol/ipratropium nebulizer treatments or to a dose of IV corticosteroids. He is getting worse, and you do not know what other treatment options are available. You remember hearing that magnesium might help asthma, but you do not know if it will help. You do not have a medical librarian handy, and so you turn to Twitter for help: “Can anyone tell me if magnesium has good evidence recommending its use in patients with severe asthma?” #DukeEBM

S2: You just returned from a crackerjack EBM conference at a major research and medical university. Your sponsoring institution is very excited to hear about what new and wonderful information and insights you have brought back to share. As you are finishing morning clinic 30 minutes before the weekly noon conference, you get a call reporting that the planned speaker has cancelled and you are needed to step in! The schedulers feel you will cover nicely, since thanks to the EBM conference you undoubtedly can discuss the Newest and Best evidence on anything…so why not COPD? You panic, and with 3 patients left to see you have no time to search for anything! In a moment of desperate hope, you tweet “Re: best evidence-based treatments for COPD–can anyone lead me to best evidence-based guidelines?” #DukeEBM

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At my institution, I am one of the few physicians that I know that uses social media regularly and readily.

Last week, I was offered a chance to discuss social media and healthcare at the Virginia Commonwealth University’s Department of Internal Medicine Grand Rounds. I hope to be able to find a recording, but for now I provide the presentation’s PowerPoint in case you would like to review it:

In this post, I described why I think physicians benefit from being active in social media. The combined benefits of enhanced partnerships and new connections, keeping up to date with recent clinical and health policy information, and expanding one’s understanding of healthcare from the perspective of patients and other health care providers are valuable outcomes that all physicians should value. After all, why do we read journals, attend CME, watch webinars and listen to conference calls? To keep our clinical knowledge up to date in order to provide the best care for our patients and to learn from each others’ experiences. Active participation in social media can provide those same benefits.

Over the last couple of years, I have seen more and more family physicians becoming active on social media, especially on Twitter. I have been trying to keep a list of all the FPs (and GPs) I have encountered on Twitter, though I know that this must be incomplete. A quick scan of the list, however, shows the breadth of perspectives and opinions held by family physicians, and gives insight into the challenges and the rewards of being a family doctor.

Many family medicine doctors on Twitter use the #FMRevolution hashtag as a way to organize and share ideas. I believe that family medicine can, and should, be even more active on social media. In fact, I believe that family medicine should be the prominent medical specialty in social media and especially on Twitter. Here are the reasons that I believe should impel more family medicine physicians to be active in these settings:

Family medicine believes in empowering our patients to take an active role in their care. Social media is a prime venue for patients who are seeking to learn from each other and share experiences. The e-patient movement makes active use of social media to inform themselves and each other about health, wellness, and specific illnesses. Physicians are all-too-rarely part of that discussion. With the breadth of knowledge family physicians have, we can be an active part of these discussions, and we can help ensure patients have accurate and reliable information. Family medicine’s bio-psycho-social approach to care, which enables us to provide capable and effective care for patients with chronic illness, would also be valuable in discussions with engaged and empowered patients who are seeking to improve their own health statuses.

Family medicine still suffers from a lack of understanding of what it entails. As noted in this recent post, primary care and family medicine are not usually given starring roles in the media, and are often confronted with the argument that the role of family physicians can be easily assumed by NPs and PAs. By talking about our careers, our practices and (within the bounds of patient privacy and confidentiality) our patients’–their illnesses, struggles, and victories–we can control the message and we can show the public what it means to be a family medicine physician.

For many years, it has been difficult to recruit US medical students into family medicine. Now that more and more medical students are using social media for their own purposes, we could act as virtual role models and mentors. If there is a robust and vibrant family medicine community online, if we discuss what we love about being family physicians, we might encourage medical students (and premedical students) to look at a career in family medicine.

Family medicine can be a voice of advocacy online. As seen in Mike Sevilla’s#SaveGME campaign, when family docs organize we can have a notable reach. The #SaveGME initiative was a short-notice, one-time effort to discuss the importance of protecting GME funding, but even with this limited preparation the group was able to reach tens of thousands of people. Imagine if all family physicians on social media organized to advocate on key positions: I suspect we could reach hundreds of thousands of people.

Finally, family medicine should be the most prominent voice on social media because we represent one of the largest medical specialties in the United States. I think there are more members of the American College of Physicians (ACP) than in the American Academy of Family Physicians (AAFP), but this is deceptive: many of the ACP’s members are sub-specialty physicians (Cardiology, Pulmonary/Critical Care, etc) who do not provide full-service primary care. The American Academy of Pediatrics (AAP) lists approximately 60% of the AAFP’s membership. There are more primary care physicians in family medicine than in any other specialty…and we should be willing to use that fact to ensure that our voices are heard loud and clear.

Family medicine’s leadership has already understood the importance of strong family medicine voices on social media. The AAFP’s President has a Twitter account, the AAFP Twitter account is updated regularly, various AAFP board members are on Twitter (Reid Blackwelder being the most active), and the STFM Twitter account is interactive and valuable. Other family medicine physicians should follow these leads: with increased involvement, family medicine’s voice should be at the center of healthcare discussions on social media.

In a previous post, I made an argument as to why physicians should be involved in social media—especially on Twitter. The purpose of this post is to describe how I use social media as a busy clinician and teacher of family medicine to keep up to date with clinical and policy information and also how I find the time to use social media. Yes, social media can fit into a busy schedule.

One of the most daunting challenges facing any newcomer to social media is the volume and scope of information that is available. Once one starts following other social media accounts, the incoming “stream” of information can quickly become overwhelming. A number of social media participants have likened it to drinking from a fire hose.

In many cases, these streams of information are also not uniformly useful: friends’ updates may be personally important, but can make it harder to find relevant clinical or policy information. It can also become quickly apparent that trying to keep up with every update on Twitter or Facebook is an exercise in futility and will take up the better part of your life.

Here are some tips that I have found useful:

Stop trying to read every update. Early on, when I was new on Twitter, I would try to read every single update posted and visible in my timeline. This took a ridiculous amount of time. Instead, I have come to understand that I cannot read every update. Instead, when I log into my accounts, I’ll glance at what updates are there and look back a bit at previous updates. I trust that anything that is really important will be shared or commented upon more than once, and I have come to appreciate the randomness and serendipity associated with dipping my toe in the stream every now and then.

Organize your incoming information: this is one of the most valuable tricks that I have found. Instead of trying to search my overall Twitter feed (I follow nearly 1,500) accounts, I have created lists that allow me to focus on certain themes. I have a list for updates regarding health policy, clinical updates, family medicine-specific accounts, people in Richmond, etc. Perhaps the most useful is the list I’ve titled “essentials”: this list includes accounts that have an especially high value for me whether it is because of the quality of material they share, the topics in which they are interested, etc. When I have only a short window of time, I can skim the essentials list and get high quality information in short order. Given that I use social media as myself and as administrator for a few organizational accounts, this list lets me find information I can share from various accounts.

Each social media user has different times of day when they might review their accounts: over breakfast, at lunch, etc. However, you can make use of “interstitial time” (credit to Paul Tatum). If you have a computer or mobile device available, you can glance at your stream during the time that you’re waiting for the nurses to room a patient, or if a patient no-shows. These short windows of time can add up.

Look into using a third-party Twitter client, such as TweetDeck or HootSuite. Twitter clients allow you to better organize the incoming information, and let you see multiple lists simultaneously. If you are sharing information, Twitter clients also allow you to share on different platforms (Twitter, Facebook) and via different accounts. This is a tremendous time-saver. I am not beholden to any particular client: I use TweetDeck on my laptop, HootSuite on my mobile devices, as it seems to be a better fit for them.

Leverage your e-mail newsletters. If you subscribe to any e-mail newsletters, you can use them to find resources that you can then share to your account’s followers. For example, the American Academy of Pediatrics Smart Brief includes short capsules of useful information. You can read the capsules, click to read the full article, and then share that directly to your social media accounts. This prevents you from duplicating work, and allows others to see information you found to be relevant. You can do the same with Physicians First Watch, and numerous other sources.

In summary, do not be afraid that being on social media will inundate you with useless information and eat up any and all free time. There are ways to compress and increase the efficiency of your social media use to ensure that you find what you want to find, share what you think is relevant, and make meaningful connections with other users.

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About a month ago, I received a request from one of my practice partners. They are working with a patient with a number of chronic, hard-to-treat medical illnesses that may or may not be part of a single syndrome or underlying problem. Despite the fact that this physician is an excellent clinician, they have struggled to put the pieces together and are worried that they are missing something.

The e-mail they sent me reads “i have a patient with an odd constellation of chronic medical problems…it seems to me something might tie these together…i mentioned to the patient the crowdsourcing idea on twitter and he was open to trying this”

I have spoken with this physician, but I have not spoken personally with the patient yet. I have not taken any steps to crowdsource this patient’s illness because I am honestly not sure how best to do it…or even if itshould be done.

So: I would like to crowdsource the ethics of crowdsourcing. I am hoping to hear from other physicians, but especially from patients and patient advocates who have faced challenging illnesses and diagnoses.

Is it appropriate (with a patient’s permission, of course) to post a patient’s medical history in a public forum as a way to consider and evaluate possible diagnoses?

If so, what sort of permission is necessary? Is there some sort of consent form that one can use to ensure that patients understand what it means to have their medical history posted on social media? If a patient’s symptoms are unique enough, then they can presumably be identified by a reader, so how can this information be posted (or what sort of waiver/consent is needed) to ensure that HIPAA is not violated?

I would presume that making the information visible and accessible to the patient would be the best approach–for example, posting as a blog update that they can review and upon which they can comment even during the discussion among physicians.

How much do we need to vet this idea/process–if it goes forward–with our health system’s legal department?

I think that there could be great value in using social media as the world’s largest “curbside consult” in which we ask peers to provide suggestions and insight but the primary physician retains sole responsibility to determine treatment plans with their patient. In essence, the crowdsourcing would be like an enormous brainstorming session to help come up with ideas that the primary physician might have overlooked or failed to consider.

Please send me your thoughts–feel free to comment below. This feels like an awfully large step, and one that I do not want to take into thin air.

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I wanted to take an editorial prerogative for a moment to comment on the recent action (or lack thereof) on the blog.

The three of us contributing to the blog (myself, Carmen Gonzalez, and Mark Dimor) have all been busy working on a number of other projects, with the OccupyHealthcare blog project at the top of the list. However, we’ve just also been busy keeping up with life and new obligations.

We will still post and update the blog, but it will happen less frequently than before.